老人呼吸衰竭的治疗老人呼吸衰竭的治疗.doc

摘要】? 　　目的 通过监测双水平气道正压（BiPAP）无创通气对老年急性心源性肺水肿病人的影响，从而评估其临床推广使用的安全性。 方法 回顾性分析54例常规治疗效果不佳的老年急性心源性肺水肿病人，及时使用BiPAP无创通气并观察治疗效果和血流动力学参数［心率（HR）、平均动脉压（MBP）、中心静脉压（CVP）］、血气的变化［氧合指数（OI）、碳酸氢根离子（HCO-3）］。 结果 及时使用BiPAP后，患者血流动力学指标（HR， CVP）明显缓解（P0.01）；血气分析的数值（OI, HCO-3)明显改善（P0.05）；并且对多巴胺的依赖明显降低(P0.01)；总的治疗有效率高达87% 。 结论 早期使用BiPAP无创通气对老年急性心源性肺水肿并呼吸衰竭病人具有良好的效果 【关键词】? BiPAP 急性心源性肺水肿 老年人 呼吸衰竭 　　Effects of BiPAP ventilation on elderly patients with acute pulmonary edema complicated with respiratory failure? XU Zhong,?? HUANG Dongjian,??? LUO Qiaoli. Department of General Intensive Care Unit, the Third Affiliated Hospital of Guangzhou Medical College， Guangzhou? 510150， China ??? 【Ａｂｓｔｒａｃｔ】　Ｏｂｊｅｃｔｉｖｅ? To observe the therapeutic effects of? bilevel positive air pressure （BiPAP） ventilation on elderly patients with acute pulmonary edema complicated with respiratory failure.?? Ｍｅｔｈｏｄｓ? The clinical data of 54 elderly patients with acute pulmonary edema treated by BiPAP ventilation were reviewed and analyzed. During the BiPAP ventilation, the efficiency rate and the changes of arterial blood gas（OI, HCO3) were measured. The hemodynamic parameters（HR，MBP， CVP） were detected.? Ｒｅｓｕｌｔｓ? The patients receiving BiPAP ventilation showed more significant improvement of the efficiency rate （87%） and the hemodynamic parameters （HR， CVP） were decreased obviously（P＜0.01） during noninvasive ventilation. The changes of arterial blood gas （OI, HCO-3) were improved significantly（P＜0.05）, and the dose of dopamine was also decreased obviously（P＜0.01）.? Ｒｅｓｕｌｔｓ? The BiPAP ventilation is safe for elderly patients with acute pulmonary edema. ??? 【Key　ｗｏｒｄｓ】? bilevel positive air pressure; acute pulmonary edema; aged; respiratory failure ??? 近年来，我国随着人口老龄化的出现，老年人急性心源性肺水肿的发生率呈逐年上升的趋势。对于这种常见的内科急症大多数患者可以通过氧疗的常规药物治疗得到纠正，但是部分患者常迅速合并呼吸衰竭，危及生命,及早使用无创通气可提高患者的氧供，改善其预后［1］。虽然双水平气道正压(BiPAP)具有创伤少、经济、方便等优势，但是, 由于对这类病人因应用无创通气所造成的影响所知甚少，从而在一定程度上限制了其广泛的使用。因此，本文就上述情况进行深入的研究，力求为进一步在临床推广BiPAP在老年急性心源性肺水肿中的应用提供更为全面的理论和依据,现将研究结果报道如下。